Transactions of the Medical Society of London

Art. 13. Observations on the Use of the Bark of Szoietenia Febrifiiga. By W.Roxburgh, M.D. About the year 1791, Dr. R. published some observations on this bark ; and between that period and 1806 (the date of the present paper) the medicine had been successfully used as a febrifuge in various parts of the world. Documents from numerous practitioners are here brought forward in support of Dr. Roxburgh's observations; but it is unnecessary to transcribe them, as they may be referred to in the volume itself. Dr. R, has usually given the powdered bark in substance, mixed with cold water, in doses of from 20 to 60 grains, generally the latter dose. The first day it usually proves considerably laxative, but less so afterwards. He could observe no other sensible mode of its operation, except the entire removal of the disease, and an improved appetite. Little or no nausea, or any kind of uneasiness, attended its use. In some gangrenous and other bad ulcers, the Doctor continued this medicine for five or six: weeks, three or four times a day, without his observing any visceral obstructions to ensue. Affections of the spleen [ague cakes], so common after the use of Peruvian bark in hot climates, were not observed to follow the exhibition of the Swietenia.

About the year 1791, Dr. R. published some observations on this bark ; and between that period and 1806 (the date of the present paper) the medicine had been successfully used as a febrifuge in various parts of the world. Documents from numerous practitioners are here brought forward in support of Dr. Roxburgh's observations; but it is unnecessary to transcribe them, as they may be referred to in the volume itself.
Dr. R, has usually given the powdered bark in substance, mixed with cold water, in doses of from 20 to 60 grains, generally the latter dose. The first day it usually proves considerably laxative, but less so afterwards. He could observe no other sensible mode of its operation, except the entire removal of the disease, and an improved appetite. Little or no nausea, or any kind of uneasiness, attended its use. In some gangrenous and other bad ulcers, the Doctor continued this medicine for five or six: weeks, three or four times a day, without his observing any visceral obstructions to ensue. Affections of the spleen [ague cakes], so common after the use of Peruvian bark in hot climates, were not observed to follow the exhibition of the Swietenia.
Art. 14. Case of Hydrophobia. By White, Esq. Assistant Surgeon of the Westminster Infirmary.
This was a young man 19 years of age, who was seized "with symptoms of Hydrophobia six weeks after the in-32 Miscellaneous Remarks on Medical Subjects. fliction of the bite. The phaenomena were similar to those recorded in other histories of this dreadful malady, and the result was the same ?death.
Blood-letting, opium, digitalis, were the remedies employed, but without effect. " The only fact (says Mr. White) we have gained from the treatment of this case isy that the sensorial powers cannot be affected by the administering of opiates, which class of medicines may, in future, be laid on the shelf. Indeed, the presence of hydrophobia appears to render the body not amenable to the operation of medicine in any degree." 18S.
Art. 15. Miscellaneous Remarks on Medical Subjects. By James Sims, M. D. After sixty years' sltidv and practice of physic, Dr. Sims has retired, and conceives that he cannot be better employed in conquering the indolence of age, than in collecting such observations as he has made in his own long and extensive practice. " I cannot help wishing (says he) that the press gave us more empirical observations from aged physicians, than fine-drawn theories and hypotheses by young ones." To this we say, Amen ! But why call them empirical observations ? Yet the old gentleman does not disdain to rear up a delicate little theoretical chicken as a bonne bouche for himself and the Society. It comes forth, too, in the plumage of an empirical observation ! It is this : Boerhaave having said (or somebody for him), that " he should be able to cure almost every disorder incident to the human body, if he could produce, at pleasure, an ague," Dr. S ims proposes transporting the inhabitants of Bedlam, and all other lunatic asyla, to Essex and Lincolnshire ? for the benefit of the air! Blood-letting Dr. S. has not found serviceable in mania; but in melancholia the case is often different. " If the patient complains much of oppression on the head or brain, and seems much paler and weaker than preceding circumstances would lead us to expect, I have often seen great service from taking blood either by the lancet, by cupping, or by leeches applied to the temples. In this latter case I have also found wine, spirits, and all cordials and stimulants, eminently hurtful, though they would seem so proper to raise the pulse and spirits. This elevation is most certainly procured by bleeding, when that has been properly administered." l?)2.
Dr. S. thinks that the alarming increase of insanity in this country is owing to the following causes: 1, The too Miscellaneous Remarks on Medical Subjects. S3 great use of animal food and high sauces. 2. The inordinate consumption of strong vinous liquors: spirits, he thinks, produce phrenzy and sudden death. 3. The auri sacra fames, or rage for money.
2. Second Empirical, or rather Empirico-hypothetical Observation. ?The hot-wells of Bristol, some years back, deservedly acquired a character for curing many bad cases of consumption. At present their estimation is on the wane, owing, as Dr. S. thinks, to the imprudence of the builders, and not to the ultra-approbation of Beddoes, as some of the proprietors imagine. The original low, warm, sheltered situation, where the patients resided, is now changed to a bleak hill nearly three hundred feet in perpendicular height above the old Wells. This is a very inconvenient site for pulmonic patients, as it is almost constantly visited by violent gusts of north-west winds from the Welsh mountains, and from the sea up a deep valley gradually more and more pent in, until they are at last discharged, with their accumulated force, upon Clifton.
Most of our consumptive patients are seized with the complaint in hilly situations; and therefore a low ground would probably be favourable to recovery. The following case strongly corroborates the theory of Dr. Wells : " A young lady, obviously far gone in a pulmonary consumption, applied for my advice since I quitted practising my profession for gain. As I thought she could only be saved by uncommon methods, I advised a removal to a very aguish part of Essex. As I thought she might require medicines whilst there, I agreed to accompany her to a relative's house on the spot. The consequence was, that, within three days, she was seized with a tertian intermittent, and did not cough once after the second fit of the ague. I kept her there until she had seven or eight regular returns of the paroxysm, and then, bringing her to London, easily stopped the ague with proper remedies." 198.
Much do we fear that few such recoveries from genuine phthisis would follow a Lincolnshire or Essex ague. The case, however, is worthy of record ; and the practice of imitation in such an opprobrium medicorum.
3. The Brine Bath. ? Dr. Sims has been above forty years in the habit of ordering, for various patients, a brine bath, made in the following manner : " Take as many gallons of water as will fill a third of the bathing-tub you intend to use; to this add about as much com-19 F 34 Miscellaneous Remarks on Medical Subjects. mon sea salt as there was water.
If the water be boiling at the time of using it, the whole will be immediately dissolved ; if not, some of the salt will remain granulated in the bottom at first, but which will be gradually dissolved." This bath will keep good for years. Any scum that gathers on the top is to be carefully taken off, and all dust to be kept out. Nervous weak persons, adds our author, often cannot bear a cold bath of common water, but will bear this with ease* People come out of it with a glow on their skin, and very agreeable sensations.
4. Infallible Styptic for Epistaxis. ?This is made by lighting a piece of common cork at a candle, and, as it burns, by scraping off gently the black burnt powder. ]t is to be strongly and repeatedly snuffed up the bleeding nostril, and ?"I never knew it to fail"? except in one instance.
" Indeed its effect, in these cases, is so instantaneous as to seem like magic." p. 202. This is a genuine specimen of empirical observation.

5.
Sulphate of Zinc.? Dr. S. lauds this emetic in high terms.
Extraordinary Tumour, supposed Aneurismal. himself by resolving to put nothing in his mouth hotter than his own blood. Dr. S. was led to this cure by a curious piece of philosophy; namely, because "he knew that hard bodies (for instance the teeth) were mo^t liable to be dilated and contracted by heat and cold." At this rate real silver would make a better thermometer than quicksilver ! 9. Cramps in the Limbs of gouty Peopje.? Dr. Sims, conceiving that these arose from loo free a return of blood from the lower extremities, when the person was in bed, and from the want of garters, as in the day. Garters, therefore, seemed the cure; and the first fee the Doctor ever received was for prescribing a pair of garters.
10. This article is a desperate long one on the Materia Medica; but as we were unable to comprehend its drift, we refer the reader to the work itself. Another long article, .on the Language cf the Fingers, Elbows, Sic. follows ; but as it is not calculated for our class of readers, we shall pass it over.
Mrs. K. a young woman, fell in labour, and was attended by a midwife, who called in Dr. Squire. On examination, no entrance could be perceived into the vagina. Oil more minutely examining the parts, a small aperture was observed in the anterior part, near the orifice of the urethra, just large enough to admit the introduction of a, small goose quill. Through this the end of a director was pointed towards the perinseum, and the intervening substance was divided along the groove of the director with a scalpel. The haemorrhage was trifling, labour came on, and all did well.
By John Moodie, M. D.
II. E. of a strong and otherwise healthy constitution, was brought to Dr. Hoodie's house, July 3, 1803, and gave the following history of his case:?In the preceding March he sprained or hurt his left arm, which was followed by a painful and acute sensation in the shoulder of the same side. This partly went off in about a fortnight, but a slight enlargement of the shoulder joint was suspected, aud a blister was applied, which gave some relief. Pain, however, continuing about the articulation, 36 Case of Hydrophobia. a dislocation was suspected, and the usual means of reduction put in force without success. The tumour increased rapidly after this; and when Dr. M. saw it, it was the size of a person's head. It was tense, somewhat discoloured ; prominent at the superior part, where the skin is very thin. There is great uneasiness on pressure, but no perceptible pulsation. Being punctured at one point, a tea cupful of blood was discharged, and the orifice closed. At the depending part, the veins were varicose and reticulated. Accompanying this affection, were various symptoms of constitutional commotion and irritation.
The pulse at the wrist of the arm affected was small, intermitting, and hardly perceptible; at the other, quick and hard. In a consultation, it was considered aneurism.
The tumour rapidly increased, till it was three feet ten inches in girth. Small quantities of blood frequently issued from the surface of the tumour; and about a week before the patient's death, a large wash-hand basin full was discharged at one time. He sunk on the 2Qih of August.
Now we believe that this Journal will by this time have exhibited a parallel case, under the denomination " Heemato-scrofulous Tumour," where amputation saved life, and dissection of the limb showed that aneurism had nothing to, do in the business. We are convinced that the above case would, on dissection, have shewn precisely similar appearances.
A boy, in forcing a bolus down a dog's throat, the dog being ill but not suspected of madness, -wr.s slightly wounded by the dog's teeth. No notice, however, was taken of the accident, and the wound healed. About four months afterwaids hydrophobia completely developed itself. Blood-letting and opiates had no effect in arresting the fatal progress. There was no other morbid appearance, except that ? " the upper orifice, or cardia (of the stomach), was a little more va cular than usual, but not inflamed. In examining various dogs that died of hydrophobia, there was no other morbid phoenomenon to be seen ; the ruga? of the stomach being numerous and prominent." That this dreadful poison cannot be communicated from one human being to another, may be inferred from the following history; Mr. Green's Cases of Gout. 37 " A gentleman, far advanced in years, was afflicted with hydrophobia, and while he was in that state, desired to salute his daughter : he seized her cheek with so much violence between his teeth, that we had much difficulty in disengaging her from him ; and she did not wash off the saliva deposited in the wound." She did not suffer from the circumstance, p. 251.
Of the prophylaxis, Dr. W. thinks there is nothing but excision that can be depended upon. " I have had several cases of persons bitten by dogs afflictcd with hydrophobia, in which the part has been excised; not one of them has been afflicted with this disease, and it is now many years since the operation was performed on some of them/' P. 255.
Dr. W. recommends a trial of extract, hyoscyami in as large doses as the patient can bear; this remedy never yet having been tried.
He continued restless and in much pain until three in the morning, when he felt nausea, and had a very copious alvine evacuation ; three more stools followed, after which he enjoyed three hours sound sleep. He then repeated the draught, and by ten o'clock was able to walk down stairs with little uneasiness. The second draught made him sick, and procured several loose motions. On the third day he felt quite well and walked out. About a week alter, a walk in a sharp frost brought on an thee severe attac k of the gout. I saw him two days after, in-, capable of moving, and in excruciating pain, when he earnestly solicited the same medicine he had tried before. The first draught brought up a great deal of bile, and procured him several loose motions. It was repeated at bed-time, with the same effects ; the first part of the night being rendered uncomfortable by frequent scalding stools. At five o'clock he had four hours refreshing sleep, and on waking he took a third draught, which kept up the al? "vine discharge. Between eleven and twelve, I found him 38 Cases of fatal Obstruction in the Bozcels. walking about, the pain and gout having left his knee. He took no more medicine, and remains quite well. Mr. Green has not found any evil attending the antiphlogistic plan, convinced, from experience, that heating medicines and flannel wrappers are injurious. Where there is much inflammation, Mr. G. applies leeches. The following case, as well as the former, shews the good effects of purging in such cases:?Mr. S. about 60, accustomed to spring attacks of the gout, which last three or four months, was seized with gout in both feet, about the middle of January. On the second day of his illness he took, by my advice, three of the foregoing draughts at proper intervals, which vomited and purged him pretty smartly ; at the end of two days he was down stairs, having exchanged the three months confinement he dreaded, for trifling debility, which he soon expected to get over. He is now taking draughts occasionally of equal parts of inf. gent. c. et inf. sennaj, with a view of strengthening the stomach and promoting the discharge of colluvies from the bowels.
Art. 19. Cases of fatal Obstruction in the Bowels, zvith the Appearances on Dissection. By G. Damant, Esq.
John Morris, setat. 50, had been afflicted for twenty years with temporary bowel obstructions, attended frequently with stercoraceous vomitings, which continued about twenty-four hours, when the patient was relieved by natural evacuations. The vomiting had continued four days, when, on cailing in medical aid, the abdomen was found greatly distended ; the pain not more than might be expected from such distention. From twelve to fourteen pii.ts per diem of faeculent matter was vomited up} not more than a pint and a half of aliment was taken. His thirst was moderate, and his pulse not very quick. The physician who was consulted pronounced him in imminent danger. He directed a simple enema, and a grain of calomel, with five grains of jalap every hour till the next day. The vomiting continued, and no effect was produced, nor would the enema remain in the rectum. Mr.
Damant endeavoured, in vain, to pass a large bougie. Sumat. sulph. in agues. 3j, 2da quaque hora. After throwing up two or three tobacco enemas, the bougie passed a little higher. The smoke of tobacco was tried nearly an hour, without inducing syncope. Sum. olei ricini coch. i. min. omni hoia. Nine ounces of the oil were taken, and the patient expired on the 11th day of the disease.
Cases of fatal Obstruction in the Bozccls.
39 Sectio cadaveris. The small intestines unusually distended, bearing strong marks of inflammation. The valvula coli perfect; no obstruction presented itself until we examined the colon ; it was contracted from its beginning to the termination of the rectum, and filled with a tenacious whitish substance which scarcely admitted the finger to pass. Water would not find a passage.
A. B. setat. 60, had been in the habit of taking purgatives for extreme costiveness. From some cause, she remained a week without evacuations, when, on the failure of her usual remedies, she applied to her medical attendant.
Finding considerable pain and sickness, he took from her eight ounces of blood, and directed her to take some opening medicine. I saw her the next day, and directed a larger quantity of blood to be taken. This did not appear so much inflamed as the last. Various remedies were tried ; much difficulty in throwing up an enema. Some liquid faeces were at last voided, but the sickness increased, and the patient vomited only faiculent matter. The tension of the abdomen was considerable, and death took place on the fourth day.